Project Summary/Abstract Americans are bombarded with so many evidence-based health care recommendations that it is impossible to do them all; for example, get a mammogram, quit smoking, and eat a healthier diet. As a result, patients tell their doctors, ?I am already getting a colonoscopy and cutting out salt for my blood pressure, so don?t bother me about my weight,? without understanding the tradeoffs between these recommendations. This proposal seeks to help middle-aged adults, often with minimal or no symptoms of chronic disease, to make an informed decision about the handful of health care services that are most likely to promote longevity. This proposal will employ a previously-published analytic model to convey the potential gain in life expectancy associated with a patient?s adherence to each major preventive care guideline. Results will be individualized for a patient?s age and risk factors, so that each person will receive different recommendations. Patients will be able to see the relative importance of each recommendation for their long-term health (even while they feel healthy now), and select targeted health-improving behaviors based on shared decision making with their provider. Moreover, risk factors will be clearly highlighted through the personalization process, so to the extent that some risks are higher among minorities, there is potential to reduce disparities. This proposal has 3 aims. First, we will work with patients and providers to develop a decision aid that will improve understanding and shared decision making about the optimal use of preventive care services. Second, we will pilot test the decision aid for middle-aged patients. Third, we will create a nightly data feed from the electronic medical record (EMR) to a web-based portal, to establish feasibility for future integration of individualized preventive care recommendations with the EMR. We will evaluate physician and patient experience as preparation for a future randomized trial of tailored disease prevention in middle-aged adults. This proposal builds upon our inter-disciplinary team?s strong foundation in shared decision-making, creating risk assessment tools and incorporating them into electronic medical records. A successful intervention will help change the paradigm of preventive care delivery in the United States, to maximize health and prevent illness in the middle-aged population.